Percutaneous carotid angioplasty and stenting with the use of gadolinium in lieu of iodinated contrast medium: Technical case report and review of the literature

OBJECTIVE AND IMPORTANCE: We describe a patient who underwent percutaneous transluminal carotid angioplasty and stent placement with the use of intra- arterial gadolinium (Gd-DTPA) instead of iodinated contrast medium. This re presents one of the first published reports of the use of Gd-DTPA as an ang iographic contrast agent for an interventional neuroradiological procedure. CLINICAL PRESENTATION: A 75-year-old man with renal insufficiency and multi ple comorbidities developed amaurosis fugax. Doppler examination revealed h igh-grade stenosis of the right internal carotid artery. INTERVENTION: The patient underwent percutaneous transluminal balloon angio plasty with endovascular stent placement for 95% narrowing of the proximal right internal carotid artery. Because of his impaired renal function, the procedure was performed with the use of Gd-DTPA as the sole contrast agent. Approximately 60 ml of contrast medium (twice the volume typically used fo r a magnetic resonance imaging study) was used. There were no neurological, renal, or other complications. CONCLUSION: Intra-arterially administered Gd-DTPA may be substituted for io dinated contrast agents in complex neuroendovascular procedures. This capac ity expands the armamentarium for interventional neuroradiological procedur es.